tbuckley/cabot-search huggingface dataset:
Abstract P179: Development and Implementation of a Large, Multi-Center Survey of Patients With Heart Failure
Authors: Alanna M Chamberlain, Erinn M Hade, Irina V Haller, Benjamin D Horne, Catherine P Benziger, Jill M Killian, Susan A Weston, Sheila M Manemann, Veronique L Roger
Journal: Circulation (2023)

Background: Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the determinants of successful self-management and the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF. Methods: We developed a survey guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. The survey was administered to HF patients from 4 health care systems participating in PCORnet® (the National Patient-Centered Clinical Research Network). Patients were identified utilizing data available in the PCORnet common data model on or after 1/1/2013 at 1 health system and on or after 1/1/2015 at 3 health systems: age ≥30 years, ≥2 HF diagnostic codes, and ≥1 HF-related prescription (positive predictive value of algorithm: 81%). Results: A total of 10,662 patients with HF were identified, 9684 were mailed a survey, and 3330 completed a survey (response rate: 35%). Responders were older than non-responders (74 vs. 71 years), less racially diverse (3% vs. 12% non-White), less likely to have reduced ejection fraction (EF; 22% vs. 27% with EF &lt;40%), and had higher prevalence of most chronic conditions. Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, more than half had difficulty climbing stairs, and more than 10% reported difficulties with bathing, preparing meals, and using transportation (Table). Nearly 80% of patients had family or friends sit with them during a doctor visit, and most (54%) manage their health by themselves. Conclusion: More than half of patients with HF manage their health by themselves even though most bring someone along to their health care appointments. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.
Abstract P101: Effect of an Intensive Lifestyle Intervention on Biomarkers of Atrial Fibrillation-Related Pathways Among Overweight Adults: The PREDIMED-PLUS Trial
Authors: Linzi Li, Estefania A Toledo, Dora Romaguera, Angel M Alonso-Gómez, Cristina Razquin, Lucas Tojal-Sierra, Miquel Fiol, Miguel A Martinez-Gonzalez, Jordi Salas-Salvado, Montserrat Fito, Alvaro Alonso
Journal: Circulation (2023)

Background: Lifestyles influence atrial fibrillation (AF) risk. Blood biomarkers can characterize the atrial substrate that facilitates the development of AF. Therefore, determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention. Methods: The PREDIMED-PLUS study is a Spanish multicenter randomized trial in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m 2 . Participants were randomized 1:1 to an intensive lifestyle intervention (ILI) program, emphasizing physical activity, weight loss, and adherence to the Mediterranean diet, or a control intervention. In a sub-sample, serum biomarkers including carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), N-terminal propeptide of B-type natriuretic peptide (NT-proBNP), and 3-nitrotyrosine (3-NT) were measured at baseline and years 3 and 5 after randomization. Mixed models were used to evaluate the effect of ILI on changes in biomarkers through years 3 and 5. Follow-up time was modeled as a categorical and continuous variable. Results: Of 481 participants (65 mean age, 40% female, 49% assigned to ILI), 453 (94%) and 442 (92%) had available samples at years 3 and 5. After 5 years, mean changes in log-transformed biomarkers were -0.01 (PICP), 0.20 (hsTnT), -0.17 (hsCRP), 0.12 (3-NT), and 0.25 (NT-proBNP). Participants in the ILI group experienced greater decreases in hsCRP or smaller increases in 3-NT, NT-proBNP, and in hsTnT to a lesser extent, as compared to the control group (Table). The ILI did not affect PICP concentrations. Results were consistent when modeling follow-up time as a continuous variable. Conclusion: Over five years, an ILI favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, and of hs-TnT to a lesser degree, pointing to specific mechanisms in the pathways linking lifestyles and AF.
Abstract 40: Score Based on Immunoglobulin G N-glycans for Cardiovascular Risk Prediction: Secondary Analysis of Two Randomized Trials of Primary and Secondary Prevention
Authors: Rosangela Hoshi, Branimir Plavša, Yanyan Liu, Irena Trbojevic-Akmacic, Robert Glynn, Paul M Ridker, Richard Cummings, Gordan Lauc, Olga Demler, Samia Mora
Journal: Circulation (2023)

Introduction: Immunoglobulin G (IgG) are post-translationally modified proteins with the addition of complex carbohydrate molecules (glycans). These glycans can modulate IgG inflammatory capacity and determine the transition from healthy to diseased tissue. Hypothesis: A glycan score based on certain IgG glycosylation patterns is associated with CVD risk and can improve model prediction. Methods: IgG glycosylation profiles were measured on baseline plasma samples from nested CVD case-control participants from 2 studies: JUPITER (NCT00239681; Npairs=162; discovery) and the TNT (NCT00327691; Npairs=367, validation). Lasso regression was used to select IgG glycan peaks (GPs). The linear combination of selected IgG-GPs that significantly associated with CVD in a mutually adjusted conditional regression comprised the glycan score (IgG GS ). CVD prediction using IgG GS was investigated controlling for clinical risk factors. Using a parametric approach, we calculated the area under the curve (AUC) with and without IgG GS . Results: From 24 IgG-GPs, Lasso selected 4 IgG-GPs that were also associated with incident CVD (P&lt;.05) in a mutually adjusted conditional logistic regression. These 4 IgG-GPs (9, 12, 19, 20) composed the IgG glycan score (IgG GS ; Fig1A), which was significantly associated with incident CVD in JUPITER after adjusting for clinical risk factors (model 2 hazard ratio [HR]: 2.1, 95% CI 1.55 - 2.84), with significant validation in TNT (HR = 1.2, 95% CI 1.03 - 1.4; Fig. 1B). The AUC was higher for the model with IgG GS (0.74, 95%CI = 0.69 - 0.81) than without (0.69, 95%CI = 0.67 - 0.71) in JUPITER; replicating in TNT: 0.72 [0.71 - 0.83] vs 0.64, [0.62 - 0.65]. The P-value for the likelihood ratio test comparing models with and without IgG GS was 5.9x10 -8 in JUPITER and .02 in TNT. Conclusions: An IgG glycan score with 4 IgG N-glycans was positively associated with incident CVD in the JUPITER primary prevention population, which replicated in TNT, a secondary prevention cohort, and improved model prediction performance.
Abstract 25: Long-Term Trends of BMI During Childhood and Adolescence Modify the Association of DNA Methylation Change at TXNIP With Glucose Change During Midlife
Authors: Hao Ma, Xuan Wang, Xiang Li, Yoriko Heianza, Lydia A Bazzano, Jiang He, Wei Chen, Lu Qi
Journal: Circulation (2023)

Background: Thioredoxin-interacting protein (TXNIP) is a central master regulator of whole-body glucose homeostasis in humans; and DNA methylation (DNAm) at TXNIP has been identified to be related to diabetes. It remains unknown whether dynamic changes in DNAm at TXNIP are associated with glycemic changes; and whether early-life adiposity changes modify such association. Hypothesis: We hypothesized that dynamic changes in DNAm at TXNIP are associated with glycemic changes in midlife, and early-life adiposity changes may modify such association. Methods: A total of 594 Bogalusa Heart Study participants who had DNAm measurements at two time points in midlife were included in this study. Of them, 353 participants had at least 4 examinations of BMI during childhood and adolescence (aged 4–19 years). The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI during childhood and adolescence. Results: We found 25.3% of participants showed greater than 5% DNAm change at TXNIP during a mean of 6.2 years follow-up. Increase in DNAm at TXNIP was significantly associated with decrease in FPG independent of cell-type composition and other covariates ( P &lt;0.001). Moreover, we found the increasing trend of BMI during childhood and adolescence significantly modified the above dynamic association. Each 1% increase in DNAm at TXNIP was associated with 2.90 (0.77) mg/dl decrease in FPG among participants with the highest tertile of incremental AUC of BMI, 0.96 (0.38) mg/dl decrease among those with middle tertile, whereas no significant association was observed among participants with the lowest tertile ( P -interaction=0.003). Conclusions: Our results indicate that changes in DNAm at TXNIP are significantly associated with dynamics in FPG in midlife, and such association is modified by BMI changes during childhood and adolescence.
Abstract MP35: Hair Cortisol Concentrations Are Associated With Greater Adiposity in Mid-Adolescence
Authors: Melissa N Sidote, Nicole Bornkamp, Sheryl L Rifas-Shiman, Amy R Nichols, Mingyu Zhang, Marie-France Hivert, Emily Oken
Journal: Circulation (2023)

Introduction: Hair cortisol concentration (HCC) is a biomarker of long-term stress. Higher HCC is associated with body mass index (BMI) and other adiposity measures in adults; however, this association is not well characterized in adolescents. Additionally, HCC differs by sex, but associations with adiposity by sex have not been well studied. Hypothesis: Higher HCC levels are associated with greater adiposity in mid-adolescence. Methods: Among 324 participants (49.1% female, mean 17.7 years) in Project Viva, we performed a cross-sectional analysis of HCC with measures of adiposity in mid-adolescence. We used multivariable linear regression models, overall and stratified by sex, to estimate associations of HCC (log2 transformed) with BMI, % body fat, and waist circumference (WC), adjusted for age and known predictors of adiposity, namely maternal education, smoking during pregnancy, pre-pregnancy BMI, age, and household income; and child sex-specific birthweight for gestational age z-scores, secondhand smoke exposure, age, and sex (for overall models). Results: Median (IQR) HCC was 2.1 pm/mg (1.0 – 4.7) and mean (SD) BMI was 23.0 kg/m 2 (3.8), % body fat was 20.1% (9.9), and WC was 80.4 cm (10.8). In adjusted models, HCC (per doubling) was associated with higher BMI (β 0.20 kg/m 2 ; 95% CI 0.01, 0.39), % body fat (β 0.42%; 95% CI 0.04, 0.80), and WC (β 0.45 cm; 95% CI -0.07, 0.96) (Figure). There was no evidence of effect modification by sex (all sex by HCC interaction p-values &gt;0.50). Conclusions: Higher HCC was cross-sectionally associated with greater adiposity in mid-adolescence. Associations were similar among males and females, suggesting a similar impact of long-term stress on adiposity between sexes. Adjustment for known predictors of adiposity does not alter the association of HCC and adiposity measures. Further research is needed to understand the temporal direction of this association.
Abstract P350: Modifiable Features of a Group Weight Loss Program: The Patient Perspective
Authors: Alice Pressman, Qiwen Huang, Nina Szwerinski, Robert Romanelli, Catherine Nasrallah, Sylvia Sudat, Kristen M Azar
Journal: Circulation (2023)

Introduction: The Group Lifestyle Balance™ (GLB) program is an adaptation of the landmark Diabetes Prevention Program (DPP) group lifestyle intervention that is approved by the Centers for Disease Control and Prevention as a model curriculum for diabetes (T2D) prevention. While participation in the program has been associated with clinically significant weight loss and decreases in other risk factors for T2D and cardiovascular disease in community settings, participant retention and sustained engagement throughout the 12-month program have been major challenges. Little is known about participant preference for key customizable structural aspects of program delivery that are known to influence program acceptability. Hypothesis: We hypothesized that there are features of GLB that can be customized by the delivery system to enhance recruitment and retention. Methods: We conducted a discrete choice experiment at Sutter Health, a large integrated healthcare system in northern California. We invited 122,744 patients who met DPP eligibility criteria and had elevated BMI (&gt;25), to complete an online survey. The questions were constructed to address four aspects of the structure of the program: delivery mode (in-person vs online); timing of sessions (day and time of day); facilitator (lifestyle coach vs. lifestyle coach with extra formal training); session format (group vs group plus 1:1). Three cohorts answered four different questions - each with 2 choices to determine optimal design of the program. We also asked participants to rate qualities of the facilitator and the group according to importance. Results: Surveys were completed by 6,923 (5.6%) of those invited. Two-thirds of respondents reported they would rather meet online with live video than in-person (64.2%, 1556 of 2425) and preferred the program be set in the health system (68.6%, 1664 of 2425). Most preferred the addition of private sessions (72.8%, 3273 of 4498), and a lifestyle coach with formal clinical training (80.9%, 1962 of 2425). A plurality of respondents rated facilitator personal experience with weight management as important/very important (45.2%, 3132 of 6923) and the majority also reported importance of teaching experience, and professional training (50.0%, 3456; 71.2%, 4932; both of 6923, respectively). One-quarter reported that it was important/very important for the other participants to be of similar age and sensitive to cultural differences (25.4%, 1759; 23.7%, 1639; both of 6923, respectively). Conclusions: This study identified patient preferences for several modifiable features of GLB (delivery mode, timing, session format) and several group factors. Understanding and optimizing these factors to meet the needs of participant subpopulations may be an important mechanism for improving intervention uptake and retention. Multivariable analysis is forthcoming to determine preferences for subgroups.
Abstract P169: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Offspring Blood Pressure From Birth to Late Adolescence: A Prospective Study in Project Viva
Authors: Mingyu Zhang, Sheryl L Rifas-Shiman, Izzuddin Aris, Tamarra James-Todd, Emily Oken, Marie-France Hivert
Journal: Circulation (2023)

Introduction: Mice studies showed that prenatal PFAS exposures increase offspring blood pressure (BP), but findings in human studies are inconsistent. Prior studies did not have repeated BP measurements from birth to late adolescence or use a mixture approach to investigate the interactions or overall effects of prenatal PFAS exposures. Methods: Participants are from the prospective pre-birth cohort Project Viva. We measured PFAS in maternal plasma samples collected in the 1 st -trimester (median: 9.6w) and child systolic (SBP) and diastolic BP (DBP) at six follow-up visits: 1) birth; 2) infancy (median: 6m); 3) early childhood (median: 3.2y); 4) mid-childhood (median: 7.7y); 5) early adolescent (median: 13.0y), 6) mid-adolescent (median: 17.5y). At each study visit, BP was measured 4-5 times, and the average value was taken. We used linear regression to examine associations of each individual PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with BP at each visit, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, parity, smoking status, and chronic hypertension before pregnancy. Results: Sample sizes at each visit ranged from 549-919 ( Legend ). Prenatal PFAS was not consistently associated with offspring SBP or DBP across all visits. PFOS was associated with higher SBP in mid-childhood ( Panel A1 ), EtFOSAA was associated with higher SBP in infancy and in mid-childhood ( Panel A5 ), and MeFOSAA was associated with higher SBP in infancy ( Panel A6 ). PFOS, PFNA, EtFOSAA, and MeFOSAA were associated with lower DBP only in early childhood but not at other visits ( Panels B1, B4, B5, B6 ). BKMR did not suggest prenatal PFAS interactions or the overall effects of exposure to multiple PFAS on offspring SBP or DBP. Conclusions: There are no consistent associations between prenatal PFAS exposures and BP from birth to late adolescence. Future studies should examine whether there are other critical windows (e.g., mid- or late pregnancy) of susceptibility for PFAS on offspring BP.
Abstract MP75: History of Infertility is Associated With Midlife Cardiovascular Health in Females
Authors: Amy R Nichols, Sheryl L Rifas-Shiman, Karen M Switkowski, Jessica Young, Marie-France Hivert, Jorge Chavarro, Emily Oken
Journal: Circulation (2023)

Introduction: Infertility, the inability to conceive for ≥12mo (≥6mo if age ≥35y), has been associated with increased risk for adverse cardiometabolic outcomes, but risk related to specific domains of cardiovascular health remain unclear. Utilizing the American Heart Association’s Life’s Essential 8 (LE8) construct of cardiovascular health, we hypothesized that history of infertility would be associated with lower LE8 score (0-100) comprising four behavioral (diet, physical activity, sleep, smoking status) and four biological (BMI, blood pressure, blood lipids, glycemia) domains. Methods: Project Viva enrolled pregnant participants 1999-2002. We included participants who completed a midlife visit at approximately 18y postpartum (mean age 50.6y). Using multivariable linear regression, we examined relationships between any history of infertility (y/n) and mean LE8 overall, behavioral, biological, and individual component scores adjusted for race/ethnicity, education, household income, and age at midlife visit. Results: At midlife, 468 participants had complete data. The majority (67%, n=313) identified as non-Hispanic White and had a mean (± SD) LE8 overall score of 76.3 ± 12.2, behavioral score 76.5 ± 13.4, and biological score 76.0 ± 17.5. Overall, 35% (n=160) reported experiencing infertility in their lifetime. In adjusted models, estimated LE8 overall score was 3.3 points lower (β=-3.31, 95%CI -5.63, -0.98) compared to those with no history of infertility; a stronger association was detected for the biological (β=-4.64, 95%CI -8.13, -1.16) than the behavioral domain (β=-1.97, 95%CI -4.52 ,0.58). Of individual LE8 components, infertility was most strongly associated with a lower score for blood lipids (β=-8.77, 95%CI -15.1, -2.43) and glycemia (β=-4.84, 95%CI -8.71, -0.97) (Figure). Conclusion: A history of infertility was associated with lower overall and biological cardiovascular health scores and may indicate the need for enhanced cardio-preventive strategies during the reproductive years.
Abstract P331: Higher Allostatic Load Score is Associated With Early Cardiovascular Risk in Young South Africans. The AfricanPREDICT Study
Authors: Annemarie Wentzel, Ruan Kruger, Wayne Smith, Esme Jansen van Vuren, Aruba Chowdry, Edmond Wonkamtingang, Niel A Hanchard, Stephanie T Chung
Journal: Circulation (2023)

Background: The Allostatic load score (ALS) is a composite score that measures the cumulative physiological burden of sustained exposure to stress and biological dysregulation. ALS has markers capture risk in 4 domains (neuro-endocrine, metabolic, cardiovascular, and immunological). Higher ALS in adults predict cardiovascular disease (CVD), but it is unknown whether ALS is associated with CVD risk in youth and young adults (YA), and whether the risk and association would differ at such an early age. Aims: In youth and YA we compared 1) the total ALS; 2) the cardiovascular profile according to high and low ALS; and 3) the association of ALS with markers of CVD. Methods: Participants in the African PRospective study on the Early Detection and Identification of Cardiovascular disease and HyperTension (AfricanPREDICT) were 587 youth&lt;24years (48% Male, 21±2 years) and 579 YA≥24years (49% Male, 27±2 years) were evaluated. The ALS was calculated from fasting biomarkers using the upper quartile population distribution of dehydroepiandrosterone (DHEA), cortisol, interleukin-6 (IL-6), C-reactive protein (hsCRP), BMI, systolic-BP, diastolic-BP, and lower quartile of HDL-cholesterol. The upper quartile of ALS in the whole population was defined as high ALS. Retinal vessel analyses, pulse wave velocity, and echocardiography were obtained and associations with ALS determined by regression analyses adjusted for sex, ethnicity, cotinine, gamma-glutamyl-transferase (GGT) and physical activity. Results: ALS median range was 1-8, and a high ALS of &gt;3 was observed in 35% of youth, and 47% YA. In youth with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.16, β-coefficient, -1.73, (95%CI), -2.95, -0.94), P =0.052), greater pulse wave velocity (Adj R 2 :0.56, 0.75 (0.48, 1.98), P =0.021), increased left ventricular mass index (Adj R 2 :0.61, 2.21 (0.43, 8.46) P =0.048), lower left ventricular function (global longitudinal strain) (Adj R 2 :0.37, -0.45 (-1.06, -0.06) P =0.015). Similarly, in YA with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.43, -4.54 (-6.58, -2.50), P &lt;0.001), greater pulse wave velocity (Adj R 2 :0.44, 0.62 (0.09, 1.17), P =0.043), increased left ventricular mass index (Adj R 2 :0.53, 2.62 (1.52, 5.76) P =0.032), lower diastolic function (E/A ratio) (Adj R 2 :0.27, -0.11 (-0.18, -0.04) P =0.002). Conclusion: Youth and YA with high ALS had a more adverse CVD risk profile and greater association with markers of cardiovascular aging compared to their low ALS counterparts. ALS and allostatic dysregulation should be evaluated in youth and YA, when assessing current and future cardiovascular risk.